AccountId: 011433970860
ContactId: ac69a10b-2fb8-4833-aff8-9ed236905fd8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366160 ms
Total Talk Time (AGENT): 140198 ms
Total Talk Time (CUSTOMER): 161025 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/ac69a10b-2fb8-4833-aff8-9ed236905fd8_20250224T17:57_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Um, yes, this is, my name is [PII] excuse me, [PII]. I'm calling about a some claim information that I uh sent in.
[AGENT][NEUTRAL] OK, and Mr. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0246.
[CUSTOMER][NEUTRAL] 9515
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And Mr. [PII], verify your date of birth, mailing address and email address for me, please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I reside at [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Email [PII], like my name is spelled [PII], all together, [PII].
[AGENT][POSITIVE] OK, thank you, give me one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] You say you're calling about a claim, correct?
[CUSTOMER][NEGATIVE] Yeah, I already sent all the information and my tax return, all of that stuff, and I'm and I'm already getting.
[CUSTOMER][NEGATIVE] It's been some time already and I'm starting to receive bills again from the.
[CUSTOMER][NEUTRAL] The, the doctor's office, but I sent this information in about, I don't know, 3 weeks, maybe a month ago, so I'm wondering what's going on.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Uh, it looks like the claim that process is needed the itemized billing with diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Yep I send all that in. I send all that in.
[CUSTOMER][NEUTRAL] About the bills from a line of health, I sent, I sent the complete bill in and then I sent a separate bill in for each one of them.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] In a, in a manila envelope.
[CUSTOMER][NEGATIVE] You should have received it by now.
[AGENT][NEUTRAL] OK, and when was that thing because I'm trying to, last time we received uh received on [PII] and it was processed on [PII].
[AGENT][NEUTRAL] And I'm looking at the information received and it doesn't have diagnosis codes um for these visits.
[CUSTOMER][NEUTRAL] What's that mean? I mean, I sent the bill. I.
[AGENT][NEUTRAL] Uh, the
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, because I just sent the bills straight to you guys and that's what you said you needed itemized bills and I had like 9 of them.
[CUSTOMER][NEUTRAL] And each bill was a separate bill, so that's itemized.
[AGENT][NEUTRAL] Uh, like I said, it does not have the diagnosis codes needed. Diagnosis are the reason for the visits or reason for the treatment performed. I show procedure codes, which it shows procedures like for an office visit and looks like lab targets, but um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We are needing the billing with the diagnosis codes.
[CUSTOMER][NEUTRAL] So you just need diagnosis codes now.
[AGENT][NEUTRAL] Uh, billing with diagnosis codes, yes, sir. Uh, you can contact the billing department, um.
[AGENT][NEUTRAL] And request that or uh
[AGENT][NEUTRAL] it's like a walkout statement or go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Oh, I'll, I'll, I'll just request it.
[CUSTOMER][NEGATIVE] Well, what did you guys receive anything from me or not? Because I don't see why the, huh?
[AGENT][NEUTRAL] We did.
[AGENT][NEUTRAL] We did. We have received billing from you, but it has procedure codes, but no diagnosis codes, given the diagnosis, the reason for the visits.
[CUSTOMER][NEUTRAL] OK, diagnosis codes.
[CUSTOMER][NEUTRAL] So I'll call them and let them know I need the diagnosis codes then. OK.
[CUSTOMER][NEUTRAL] And that's all that you guys need then?
[AGENT][NEUTRAL] Uh, yes, sir. And you can request what is called walkout statements. Uh, usually have the diagnosis code or descriptions uh for the date, and you can submit that into it.
[CUSTOMER][NEUTRAL] Hold on, hold on. Walk out statements.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got.
[CUSTOMER][NEUTRAL] 06 codes.
[CUSTOMER][NEGATIVE] Well, how come you guys didn't have that in the description of information that you needed in the letter that you sent me the first time with diagnosis codes, otherwise I would have had that.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, it is listed on the claim form, uh, information is needed to submit a claim.
[CUSTOMER][NEUTRAL] How you
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] OK, alright, well, let me get that from the, these, uh, them because it's already been over a month and they're talking about claims. This is getting ridiculous. I don't understand what I'm even paying you guys for. I almost wanna just pay it myself just so I don't have to go to claims because this is just taking way too long.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEGATIVE] This is absolutely ridiculous.
[AGENT][NEUTRAL] I understand your frustration, but they, in order for us to process claims, uh, we do need the information with the diagnosis, uh, showing if it's for sickness or an injury as well as billing. And like I said, it's listed on the claim form, but if you can submit that to us, they can go back and reprocess.
[CUSTOMER][NEGATIVE] I don't even know what I'm paying you for.
[CUSTOMER][POSITIVE] All right, I'll see what I can do. Thank you.
[AGENT][POSITIVE] Uh yes, sir. Thank you for calling APL. Have a great day.